Depression

Depression is more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding, treatment and a good recovery plan. With early detection, diagnosis and a treatment plan consisting of medication, psychotherapy and lifestyle choices, many people get better. But left untreated, depression can be devastating, both for the people who have it and for their families.

Some people have only one episode in a lifetime, but for most people depression recurs. Without treatment, episodes may last a few months to several years. People with severe depression can feel so hopeless that they become a risk for suicide.

An estimated 16 million American adults—almost 7% of the population—had at least 1 major depressive episode last year. People of all ages and all racial, ethnic and socioeconomic backgrounds can experience depression, but it does affect some groups of people more than others. Women are 70% more likely than men to experience depression, and young adults aged 18–25 are 60% more likely to have depression than people aged 50 or older.

Getting a comprehensive evaluation is important. Underlying medical issues that can mimic a major depressive episode, side effects of other medications (like beta blockers or antihypertensives) or any other medical causes need to be ruled out. Understanding life stressors and prior responses to treatment effort can help shape a good treatment plan. Understanding how any co-occurring conditions fit into the diagnostic picture also informs treatment options.

Symptoms

Just like with any mental health condition, people with depression or who are going through a depressive episode (also known as major or clinical depression) experience symptoms differently. But for most people, depression changes how they function day-to-day.

Changes in sleep. Many people have trouble falling asleep, staying asleep or sleeping much longer than they used to. Waking up early in the morning is common for people with major depression.

Changes in appetite. Depression can lead to serious weight loss or gain when a person stops eating or uses food as a coping mechanism.

Lack of concentration. A person may be unable to focus during severe depression. Even reading the newspaper or following the plot of a TV show can be difficult. It becomes harder to make decisions, big or small.

Loss of energy. People with depression may feel profound fatigue, think slowly or be unable to perform normal daily routines.

Lack of interest. People may lose interest in their usual activities or lose the capacity to experience pleasure. A person may have no desire to eat or have sex.

Low self esteem. During periods of depression, people dwell on losses or failures and feel excessive guilt and helplessness. Thoughts like “I am a loser” or “the world is a terrible place” or “I don’t want to be alive” can take over.

Hopelessness. Depression can make a person feel that nothing good will ever happen. Suicidal thoughts often follow these kinds of negative thoughts—and need to be taken seriously.

Changes in movement. People with depression may look physically depleted or they may be agitated. For example, a person may wake early in the morning and pace the floor for hours.

Physical aches and pains. Instead of talking about their emotions or sadness, some people may complain about a headache or an upset stomach.

How a person describes the symptoms of depression often depends on the cultural lens she is looking through. In Western cultures, people generally talk about their moods or feelings, whereas in many Eastern cultures, people refer to physical pain.

Causes

Depression does not have a single cause. It can be triggered, or it may occur spontaneously without being associated with a life crisis, physical illness or other risk. Scientists believe several factors contribute to cause depression:

Trauma. When people experience trauma at an early age, it can cause long-term changes in how their brains respond to fear and stress. These brain changes may explain why people who have a history of childhood trauma are more likely to experience depression.

Genetics. Mood disorders and risk of suicide tend to run in families, but genetic inheritance is only one factor. Identical twins share 100% of the same genes, but will both develop depression only about 30% of the time. People who have a genetic tendency to develop depression are more likely to show signs at a younger age. While a person may have a genetic tendency, life factors and events seem to influence whether he or she will ever actually experience an episode.

Life circumstances. Marital status, financial standing and where a person lives have an effect on whether a person develops depression, but it can be a case of “the chicken or the egg.” For example, depression is more common in people who are homeless, but the depression itself may be the reason a person becomes homeless.

Brain structure. Imaging studies have shown that the frontal lobe of the brain becomes less active when a person is depressed. Brain patterns during sleep change in a characteristic way. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation.

Other medical conditions. People who have a history of sleep disturbances, medical illness, chronic pain, anxiety, and attention-deficit hyperactivity disorder (ADHD) are more likely to develop depression.

Drug and alcohol abuse. Approximately 30% of people with substance abuse problems also have depression.

Who Gets Depression

Depression affects people of all ages and all racial, ethnic and socioeconomic groups. But different groups of people do experience depression in different ways.

Men. For cultural reasons, men may feel more shame about their depression and simply try to tough it out or use alcohol or drugs to self-medicate. Untreated depression in men can have devastating consequences, as men are about four times more likely to die by suicide than women.

Women. Many factors unique to women’s lives play a role in whether they develop depression, including genetics, biology, reproduction, hormonal changes and interpersonal relationships.

During their menstrual cycles, many women experience behavioral and physical changes. These changes can include depressed feelings, irritability and other emotional and physical changes. Many women with depression experience worse symptoms before their periods. Women who have premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) will experience gradually worsening symptoms until menstruation starts. Researchers are exploring how the cyclical change in hormones may affect the brain chemistry associated with depression.

Many women experience a temporary mood disturbance after childbirth. But an estimated 9-16% of American women will experience postpartum depression, a disorder that occurs after pregnancy. Women with postpartum depression may find it difficult to function day-to-day because the illness can cause anxiety, insomnia, bouts of crying and thoughts of hurting themselves or the child.

Seniors. Depression in elderly people often goes untreated because many people think that depression is a normal part of aging and a natural reaction to chronic illness, loss and social transition. Depression symptoms in older people may differ from younger people’s symptoms. Depression in seniors can be characterized by memory problems, vague complaints of pain and delusions. Depression can be a side effect of some medications commonly prescribed to older persons, such as medications to treat hypertension, and conditions such as heart attack, stroke, hip fracture or macular degeneration are known to be associated with the development of depression.

LGBTQ. Lesbian, gay, bisexual, transgender and questioning (LGBTQ) people are at higher risk for depression because they regularly face discrimination from society at large and sometimes from family, co-workers or classmates. The stigma experienced by some LGBTQ people can make them more vulnerable to mental health conditions like depression.

Children and teens. All children experience ups and downs while growing up, but for some, the downs aren’t commonplace—they are symptoms of depression. Children and teens at higher risk for depression include those who have attention deficit/hyperactivity disorder, learning or anxiety disorders and oppositional defiance disorder. A young person who has experienced considerable stress or trauma, faced a significant loss or has a family history of mood disorders is at increased risk for depression.

Children with depression are more likely to complain of aches and pains than to say they are depressed. Teens with depression may become aggressive, engage in risky behavior, abuse drugs or alcohol, do poorly in school or run away. When experiencing an episode, teens have an increased risk for suicide. In fact, suicide is the third-leading cause of death among children aged 15-19.

Diagnosis

To be diagnosed with depression, a person must have experienced a major depressive episode that has lasted longer than two weeks. The symptoms of a major depressive episode include:

Loss of interest or loss of pleasure in all activities

Change in appetite or weight

Sleep disturbances

Feeling agitated or feeling slowed down

Fatigue

Feelings of low self worth, guilt or shortcomings

Difficulty concentrating or making decisions

Suicidal thoughts or intentions

Diagnosing depression can be complicated because a depressive episode can be part of bipolar disorder or another mental illness. How a person describes symptoms often depends on the cultural lens she is looking through. Research has shown that African Americans and Latinos are more likely to be misdiagnosed, so people who have been diagnosed with depression should look for a health care professional who understands their background and shares their expectations for treatment.

Treatment

Although depression can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and a treatment plan. Today, there are a variety of treatment options available for people with depression.

Related Conditions

A person with depression may have additional conditions:

Anxiety disorders, including posttraumatic stress disorder (PTSD)

Attention-deficit hyperactivity disorder (ADHD)

Substance abuse

These other illnesses can make it hard to treat depression, but successfully treating depression almost always improves these related illnesses. Successful treatment of PTSD, ADHD or substance abuse usually improves the symptoms of depression.

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